title: Potential predictors of disease progression for main-duct intraductal papillary mucinous neoplasms of the pancreas.
abstract: OBJECTIVE
  The evidence for main pancreatic duct intraductal papillary mucinous neoplasms (MPD-IPMN) malignancy is based predominantly on investigation of resected cases, and the natural history is still unclear. The aim of the present study is to investigate the natural history of MPD-IPMN and examine potential predictors of disease progression in MPD-IPMN patients who conformed to "high-risk stigmata" criteria.
  
  
  METHODS
  This study included consecutive 20 follow-up patients and 19 surgical patients with "high-risk stigmata" MPD-IPMN, in whom the diameter of the MPD was > 10 mm, branch duct was < 5 mm, and who underwent clinical follow up for ≥ 2 years.
  
  
  RESULTS
  Among surgical patients, mural nodules and MPD diameter of invasive patients were significantly different compared with non-invasive patients. On the other hand, among follow-up patients, univariate analysis revealed the following potential predictors for disease progression: diameter of MPD ≥ 15 mm (hazard ratio [HR], 20.9; 95% confidence interval [CI], 2.59-173.4; P < 0.01); and diffuse lesions of MPD-IPMN (HR, 4.46; 95% CI, 1.10-18.0; P = 0.04). On the other hand, multivariate analysis identified only diameter of MPD ≥ 15 mm (HR, 19.2; 95% CI, 1.87-198.5; P = 0.01) as a potential predictor of disease progression.
  
  
  CONCLUSIONS
  If MPD-IPMN patients have other severe complications or reasons for not undergoing surgical treatment, MPD diameter < 15 mm, negative cytology, and no mural nodules, conservative clinical follow up for several years may be an option.
authors.affiliation: Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ogura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Masuda
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kurisu
authors.forename: Shoko
authors.initials: S
authors.lastname: Edogawa
authors.forename: Akira
authors.initials: A
authors.lastname: Imoto
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012306:Risk
keywords: ERCP; IPMN; malignancy; pancreas